After the trailers for Me Before You started airing on TV, some disability rights activists began to speak out in protest. One of the many problems people have pointed out about the film is that the main character Will, who became a quadriplegic after a motorcycle accident, assumes that having a fulfilling sex life is not possible for someone with his type of physical disability.

Tepper speaks from a place of both clinical and personal experience—he broke his neck over 30 years ago and has since been paralyzed from the neck down (though he still has some sensation, and is considered an "incomplete quad"). "When I woke up in the hospital, I was still in intensive care and as soon as they took my breathing apparatus out, the first thing I asked was if I could still have children," he says. "I was 20 years old, kids weren't on my mind yet, but instinctively when you're in this position, [you think] What’s my sexual future?"

For many people who become paralyzed, the first attempt at sex again is masturbation in the hospital, Tepper says. After trying and realizing you can't experience pleasure or orgasm, it's easy to conclude that sex is pointless. This doesn't have to be the reality, though. "It’s those people who get past the point of 'why bother'" who are able to rediscover their sexuality and find satisfaction, he says.

For men and women the mechanics of sex typically can still happen post-paralysis with some assistance.

"Generally, we get erections, and sometimes more erections than we want," Tepper says. Many quadriplegic men, with all different types of injuries, have reflex erections when the penis is touched. "Someone like Will (in the movie) would have strong reflex erections," he adds. For those who don't have them, Tepper says medications like Viagra usually work pretty well. Ejaculation usually is possible with mechanical assistance, like a vibrator, though "not many will [ejaculate] inside a vagina," Tepper says. There are some medical risks associated with ejaculating, such as heart palpitations, and some men get strong headaches. For women, physiological changes like lubrication and clitoral engorgement are usually directly affected by an injury, Tepper says. Using lube, though, can make the act of sex possible. Whether or not there is pleasure associated with it, stimulation of the elusive G-spot may actually help reduce pain. "Stimulation in the anterior wall of the vagina has an analgesic effect, so it blocks pain but not pleasure," Tepper says. He adds that some studies suggest it can reduce spasticity for hours in quadriplegic women.

But a fulfilling sex life isn't just about the mechanics. Everyone wants sex to feel good, but that part is a little more complicated.

"With a complete spinal cord injury, the traditional definition of an orgasm becomes impossible, because it's dependent upon the brain up top communicating with the nerves down below," Tepper says. But orgasm for quadriplegics, and even quadriplegic women, is possible. "Response of the genitals regarding erection and ejaculation and lubrication and clitoral engorgement have a direct correlation to level of injury. Orgasm does not."

An orgasm, though, may not be what you think of as a traditional orgasm. That's where being open-minded is key. "Our minds are so powerful, so cognitive processes and attitudes and beliefs can really block a pleasurable sexual response," Tepper says. On the contrary, being open to new sexual experiences and finding pleasure in different ways can help someone have—and enjoy—sex post-injury. For example, he tells a story of a man who learned to orgasm when his girlfriend sucked his thumb. Tepper himself has learned to experience orgasmic sensations through full body massages. "We’ve shown in lab studies with women that orgasm is largely a brain-mediated response," and that for some women, focusing and using the imagination can bring strong orgasmic responses.

Feeling sexual pleasure again is more likely if a person is open to trying new things and redefining what an orgasm means.

For those who aren't open to re-exploring and redefining their sexuality, Tepper says it can be easy to write off the science and personal testimonies as bogus. But exploring the possibilities and believing it just might work can increase someone's chances of feeling sexual pleasure again sooner, instead of years down the road. "It doesn’t have to take 17 years, and my mission in life is to help people regain that feeling sooner," Tepper says. He recommends people get regular touch, through things like professional massage or adaptive yoga. Mindfulness and tantric yoga can also help you begin to understand and enjoy sex in new ways. Having a partner that you feel safe with also makes a world of difference. "The context is important," Tepper says. For many, feeling physically safe and a sense of connectedness to their partner contributes more to sexual pleasure than any physical factor will.